How Do You Balance Th1 and Th2 in Autoimmune Disease?

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This article was originally written as a guest post for The Paleo Mom.

In my last article I explained the basic roles of Th1 and Th2 in the immune system as well as how they can be imbalanced in those suffering from autoimmune disease. In this article, I am going to cover the nutritional compounds that can shift the balance between Th1 and Th2, as well as those that are known to modulate them.

How do I tell if my immune system is imbalanced?

A Th1/Th2 Cytokine blood panel is the best way for a person to find out which side of their immune system is dominant. Alternatively, a person can also participate in a supplement challenge, where they take a nutritional supplement that stimulates Th1 for a few days and then switch to a supplement that stimulates Th2 for a few days, while noting the effect this has on their symptoms. (Update: there are some newer tests that can establish Th 1 versus Th2 dominance, discussed in the comments on this post)

What is the protocol for balancing the immune system?

Dr. Kharrazian is the practitioner who has developed the protocol for treating autoimmune disease by balancing Th1 and Th2. If Th1 is dominant, he will use Th2 stimulating compounds to raise the level of Th2, and vice versa. In addition, he uses other vitamins and compounds that are known to modulate the balance between Th1 and Th2. His view is that by balancing Th1 and Th2, the autoimmune attack is lessened and the body is able to function closer to normal. He also places his patients on an autoimmune gut-repair diet (which is very similar to the autoimmune protocol). Many people have been helped by using this protocol for the treatment of Hashimoto’s disease.

That being said, balancing the immune system for those with autoimmune disease is still tricky business and baffles even the most skilled practitioners. There are many people who have had a negative experience using this type of treatment, most likely because it is easy to accidentally stimulate their dominant pathway, causing the autoimmune attack to worsen. The Th1/Th2 stimulating compounds are as follows:

TH1 stimulating compounds:

Astragalus

Echinacea

Medicinal Mushrooms (Maitake and Beta-Glucan are common)

Glycyrrhiza (found in licorice)

Melissa Oficinalis (Lemon balm)

Panax Ginseng

Chlorella

Grape Seed Extract

TH2 stimulating compounds:

Caffeine

Green Tea Extract

Pine Bark Extract

White Willow Bark

Lycopene (found in tomatoes and other red fruits excluding strawberries and cherries)

Resveratrol (found in grape skin, sprouted peanuts, and cocoa)

Pycnogenol (found in the extract of the French maritime pine bark and apples)

Curcumin (found in turmeric)

Genistin (found in soybeans)

Quercitin (a flavanoid found in many fruits and vegetables, such as onions, berries and kale)

Why is it important to know about these compounds?

As you can see, many items on the list are common and are used by many people on a regular basis. Echinacea, for example, is a common herbal cold and flu remedy, but it can cause someone with a Th1 dominant condition to worsen. Likewise, a person with a Th2 dominant condition that is drinking a few cups of coffee everyday could be unintentionally stimulating the already dominant Th2 pathway. The opposite could be true – a Th1 dominant person may benefit from the consumption of caffeine, although this gets a little messy when you add a person’s adrenal status to the mix (caffeine may help them if they have low cortisol, but they could still be Th2 dominant and have worsening autoimmune symptoms from it).

If you suffer from an autoimmune disease, chances are you are going to be sensitive to supplements that effect the immune system. Just knowing how powerful these compounds are is useful information even if you are not going to attempt to use them to balance your levels of Th1 and Th2.

Is there a safer way to balance Th1 and Th2?

Playing with the balance of Th1 and Th2 is tricky and some people do not do well with it, even under the care of a practitioner. Using vitamins and nutrients that naturally modulate the balance between Th1 and Th2 or support T-regulatory cell function is much less risky than taking supplements that directly stimulate either one. The following compounds have been shown in studies to do this:

EPA and DHA (found in fatty cold-water fish such as salmon, sardines and mackerel as well as in pastured meats and eggs in smaller quantities)

In conclusion, I believe that it is good for autoimmune patients to know which compounds stimulate Th1 and Th2 because of how they can better or worsen the progression of disease. Knowing one’s Th1 or Th2 dominance and treating with supplements to achieve balance can be helpful to some, but I don’t believe that is the best and safest approach for everyone. If you do decide to go this route, make sure to enlist the help of a practitioner who is skilled at using this treatment for autoimmune disease. A safer alternative is to focus on compounds that have been shown to modulate the immune system, in addition to implementing other strategies that have been shown to help autoimmune disease.

Mickey Trescott is a cook and one of the bloggers behind Autoimmune Wellness. After recovering from her own struggle with both Celiac and Hashimoto’s disease, adrenal fatigue, and multiple vitamin deficiencies, Mickey started to write about her experience to share with others and help them realize they are not alone in their struggles. She is a certified Nutritional Therapy Practitioner by the Nutritional Therapy Association, and is the author of The Autoimmune Paleo Cookbook, a guide and recipe book for the autoimmune protocol, and AIP Batch Cook, a video-based batch cooking program. You also can find her on Instagram.

50 comments

[…] so if your autoimmune disease is Th1 dominant you might want to be careful with this one (See this article for details). Second, powdered turmeric stains everything, so use it with caution – I always […]

These lists are extremely interesting, but now I’m more confused than ever! I was diagnosed with hypothyroidism 12 yrs ago, but after starting treatment, I’ve only really started recognising specific thyroid-related problems in the last 4 yrs (since the birth of my daughter). I only discovered a little over a year ago that my hypothyroidism is autoimmune (wasn’t told it was Hashi’s, just that I had thyroid antibodies?? Is there any OTHER form of autoimmune hypothyroidism than Hashi’s?). I’ve had problems with adult acne off/on for 8 yrs, and menstrual problems starting around the same time. On top of that, I have had 4 miscarriages in the last yr & a 1/2 (which I’ve just learned may be linked with thyroid antibodies /autoimmune dysfunction). I started a grain-, sugar- & dairy-free diet about a year ago and my acne improved. Then I learned of the Paleo diet a couple months ago and have been trying to follow it (skin is doing even better, but I’m still having mega issues with lack of energy and feeling “thyroidy”). The more I read, the more I learn about autoimmune problems, and it seems more and more foods are implicated. I’ve been under the impression that I need to avoid all autoimmune triggers (grains, dairy, legumes, eggs, and nightshades, including some spices), but it seems you’re saying here that you might not need to avoid ALL but only the ones that are specific triggers for your type of immune system (is that correct?). …But I’m not sure I can suss it all via an elimination diet (I don’t have great success with them because they take SO long. You spend weeks on a very restricted — and therefore difficult to follow — diet, and before you have the patience and time to add things back one by one while carefully recording how you feel for days afterward, you’ve already had one weekend day where you’re out and about with your family, end up eating an unplanned meal in a restaurant where you’ve had to go off-plan, and then you don’t know which of the elements you’ve eaten is causing how you feel in the days afterward. And Heaven forbid that you actually feel better after your scourge, because then you feel encouraged to go back to an unrestricted diet, which only leads to your feeling worse afterward but not having the courage to start the elimination again from scratch….). Your lists are very interesting, though, because, while I couldn’t identify any particular reaction to — or in many cases recall any experience at all with — any of the items in the Th1 list, I have loads of experience consuming some of the items on the Th2 list, and in several cases have noted a specific “thyroidic” or “hormonal” reaction to those substances (i.e. I have a very immediate, sort of hormonal reaction — I feel that achy-throat feeling and feel as if I’m about to cry, without any kind of emotional trigger — after eating soy and, more recently, kale, the latter of which I’ve read can interfere with the processing of your thyroid hormones; I also sometimes get intense cravings for lycopene, which I’ve noticed in the past while eating tomatoey foods, but I’ve more recently given up tomatoes as they fall within the autoimmune-no-no category of nightshades; and, of course, I consume either a cup of coffee per day, or a couple of green teas, or a green tea in the morning followed by an after-lunch espresso, given that the morning tea didn’t have enough caffeine to get me going). Judging by these experiences alone, would you think that perhaps I am Th2 dominant and need to focus on the Th1 stimulating foods? …Or would you say it’s impossible to know without following very precisely the Autoimmune Protocol? …I live in the UK, so I have no idea if it’s possible to get a cytokine blood analysis here (as it’s nearly impossible to get anything you need, as you have to go via a very bureaucratic & hard to understand GP-gateway system). Do you know of any international lists of labs that offer that test? Thanks!

I would love to get my Th1/Th2 profile assessed. The link above for more info is broken. Can you please provide a direct link? I have been diagnosed with Sjogren’s Syndrome and possibly Lupus. I’m very interested in controlling this w/out medication.

Dear Mickey, can you please help me, as I am a bit confused…. I am celiac and have Hashimoto as well- I was 8 months on SCD which helped a little, now it’s my third month of AIP (difficult but I manage) unfortunately I haven’t noticed any great improvments yet… and now I read that caffeine or nightshades can balance my level of TH1…okay, but it is opposite to what rules of AIP suggest…moreover I read everywhere that coffee is not good for celiacs (to my grief as I loved it)…should I still avoid coffee and nightshades (after incorpotaing them while on SCD i did not see any changes)

Hi Joanna, Sorry for the confusion. Nightshades do not balance anything (they actually make most people’s autoimmune symptoms worse) but certain nightshades (like tomatoes) stimulate Th2 and others (like ashwaganda) stimulate Th1. I am not suggesting that people try to self-treat with immune modulating herbs and substances – in fact, I think that is a very bad idea, and you stand to make yourself sicker. If you are interested in this, I suggest finding a qualified functional medicine practitioner who is experienced treating autoimmunity this way. I personally wouldn’t go this route, but I like to be aware of the various substances in supplements and food that could be affecting my autoimmunity, which is why I wrote this article.

I think if you have an autoimmune disease, giving up coffee and nightshades are a good idea for the elimination phase. If you aren’t seeing any improvement, you may need to work with a practitioner to get some additional testing done. With Hashimoto’s, AIP won’t restore your hormone levels – you still need to be on the right dose of medication if you need it.

Dear Mickey, thank you for such a quick answer,, I live in Poland and I am still looking for a good practitioner …:( I told my children I would do everything to be healthy/-ier and a promise is a promise that’s why I read, ask, try whatever I can 🙂 (I am the lucky one to give birth twice despite those horrid diseases) . Thank you so much for your fantastic blog- I recommend it to my friends as it is incredibly helpful! Joanna

This is interesting. I started a lupus flare up in early November and for Christmas we visited family in California and the weather was warm so I walked outside as much as I could to get in the warm sun and get some vitamin d. after that my flare up decreased dramatically. I’m still very tired and have joint pain but it’s not constant. How could this be? Should I spend more time in the sun to completely kick this flare up?

Dawn, yes, vitamin D is CRITICAL for those of us with autoimmune disease. Sarah Ballantyne, author of The Paleo Approach recommends at least 20 minutes of sun per day. I don’t think your observation was coincidence.. it could also be from a decrease in stress from being on vacation.

I also have celiac/hashimoto’s. Once I hit the 10 grand mark in medical bills for one year I had 12 mercury fillings removed by a holistic dentist. I did not have additional funds to detox so I was taking chlorella. Now I find out it is an immune stimulator. What can I do to detox naturally as to not stimulate these autoimmune diseases? I’m so lost. My body cannot tolerate any chelation so it has to be natural.

April, I’m sorry, that sounds like a tricky situation. I would recommend finding a practitioner who is skilled in this area, as I am pretty unfamiliar with chelation and can’t really give recommendations without a history. Cholrella can be problematic for some people with autoimmune disease and I would suggest exercising caution. Good luck!

There is so much out their for me to learn! I’m am really enjoying your all the great information you have written about. This is definitely something for me to add to my list of things to check for on my next Dr visit.

I ordered Sarah’s book The Paleo Approach and love it. But, I also ordered a bunch of Apex Energetic supplements that I take for my Hashimoto’s and found out a day too late that these supplements have things in them that are to be avoided on the diet. For example, their Vitamin D has sunflower lecithin which is to be avoided on the diet. The Tumero (Potent Tumeric) has black pepper extract in it. The Resvero (Resveratrol) has xantham gum in it. Shall I use them anyway or toss them, diet is more important? It’s just that these supplements aren’t cheap, even wholesale! Or is their a supplement company that is recommended? Also, X FLM is the product from Apex to take for TH1 dominance, but has grape seed extract in it, which on your list says stimulates TH1. Everything else in this product stimulates TH2- Green Tea, Resveratrol, pine bark etc. Is that a mistake that it is on the Th1 list?

Sheila, I definitely wouldn’t toss the supplements, but maybe save them for a later time to try and introduce after you are feeling better? I don’t think they would be a good idea to start at the beginning of your AIP protocol. Of course this is different if you are working with a practitioner who has recommended AIP in addition to these supplements.

One of the problems with Apex products is that they have a lot of ingredients, and they don’t seem to be formulated well for those of us who are very sensitive to immune stimulants. It is not a mistake that GSE is on the TH1 stimulating list, it appears that X-FLM was formulated to be an anti-inflammatory supplement instead of an immune modulating one. I’d be careful with these products and take the advice of a practitioner.

Thank you for this article and for the comments, I’ve learned a lot from both; I’ve been taking 5! of the 8 th1 stimulating substances and only green tea (and yerba mate, I persume it works similarlyand could be listed here, right?) from the th2 stimulating compounds in the past 7 months and have actually been feeling much worse, more inflamed than ever, even though I don’t get colds and allergies like I used to. Who would’ve thought making your immune system stronger could be a bad thing?? (I have hypothyriodism and probably hashimoto’s). Thank you so much!

So. My question is: how comprehensive is this list? I have also been taking oil of oregano, cat’s claw, pau d’arco, l-lysine, guarana, citrus aurantium, acai berry, VCO, bioflavonoids, digestive enzimes, ACV and siberian ginseng to boost my immune system and would like to know if any of these belong in either of the two groups and if yes, which? I’m guessing most of these are anti-viral or immune boosting substances which is why my sinuses are clear but I have so much pain & fatigue.

I also noticed he placed GSE in the th2 stimulating list, which I had actually been thinking about before, seeing as reservatrol, most often obtained from the skin of red grapes, is also on that list (which might not mean anything, dunno :).

Thank you for you wonderful site that has helped me and many, many others so much!

Is Holy Basil safe for th1 and th2 balance as it is an ataptogen?? I was going to get some turmeric thinking that would be great for my rosacea and arthritis… glad you warned me! Thx!!! Im doing AIP now… Im hoping Holy Basil will be okay to try as it is good for stress/anxiety too which contributes to my IBS/Leaky Gut…

[…] properties (note: some people with autoimmunity can be sensitive to turmeric in their diets, read this article to find out more). You can easily come up with your own flavor additions when it comes to the […]

[…] found that actually lists supplements that stimulate different TH cells and discusses the balance. How Do You Balance Th1 and Th2 in Autoimmune Disease? | Autoimmune Paleo This had good stuff too: How Do You Balance Th1 and Th2 in Autoimmune Disease? | […]

[…] cell becomes dominant over the others, and our bodies’ defenses end up attacking us. Many herbs (including herbal antibiotics), probiotics and other supplements have a side effect of stimulating […]

[…] While this can be incredibly effective for some people, it is like playing with fire for others (read my article on Th1 and Th2 dominance for more info). If you are going to go this route, I recommend working […]

Hello all. All this information is so confusing to me. I seem to have conditions that fall in both categories for autoimmune disorders that effect both th1 and Th2. What happens when that happens? I also eat all items on the list that are said to irritate both. Thefore I’m just wondering if I should stop eating all and see how I feel. I also take vitamin d, iodide drops, omega 3, nac and a few prescription meds for sinitis and asthma. I have noticed that since I stopped eating gluten my asthma has gotten better where I have decreased my meds for that dramatically. Any information would be greatly appreciated. Thanks in advance.

Hi Penny! You are right, people don’t fit neatly into categories–this is just what research shows is likely given illnesses or conditions. The point is to be suspicious of these immune stimulants in your diet/supplements, because some can cause those of us with autoimmune issues to flare. Wishing you luck as you navigate through finding out what works for your body and best supports your health!

Hi Mickey, I do not have an autoimmune disease. However, I have severe histamine intolerance. I do feel that my immune system is imbalanced. So I quite caffeine, and stuck to the supplements that you suggested to raise my TH1. And I feel much better. However, my work is not done here, I struggle with trying to find a good multivitamin, due to my histamine issues. Can you recommend a multi-vitamin? I just cannot process histamine. I am trying to be proactive in my approach, and I don’t want to get an autoimmune disease from this. Any help you can give me will be greatly appreciated. Thank you. Lori

Hi Lori! I don’t actually recommend multivitamins, I am more in to targeted supplementation. Have you considered the option that you might have SIBO as an underlying cause of the histamine intolerance, which is very common?

[…] so if your autoimmune disease is Th2 dominant you might want to be careful with this one (See this article for details). Second, powdered turmeric stains everything, so use it with caution – I always […]

[…] doctor so he or she can proceed cautiously, particularly if you have autoimmune disease (since autoimmune disease may make you extra sensitive to certain immune stimulants). A good practitioner will be able to create an effective and balanced treatment with your unique […]

Hi, Could you tell me which probiotic is ok to to take when you are Th2 overactive immune? I have since learnt that certain strains of good bacteria should be avoided when you are Th2 dominant. I have looked in to Prescript Assist and looks like a really great product,but still can’t determine if it is suitable for Th2 dominance?

Hi Jason! I don’t have a way of knowing which probiotic will work for you–what works for some doesn’t work for everyone. I suggest introducing small amounts of different products (just like you would reintroduce a food) to assess if it is tolerable to you or not. Hope it helps!

Thank you so much for all this useful info. I have read elsewhere that mushroom supplements are good immune system modulators, so whether our immune system is under- or over-working, mushroom supplements will have the effect of balancing it. But your info suggests otherwise, and having Hashi’s especially, i should avoid mushroom supplements. Confusing 🙂

Hi Beaula! My experience is that medicinal mushrooms are powerful immune stimulants, not modulators. They’ve personally induced some powerful flares, but everyone’s experience is different! I would just say if you are going to experiment, take it slow and listen for signs things might not be working out.

First, I want to say simply: “thank you.” I have been asking various people with various levels of knowledge/experience to explain how it is possible for me to have an autoimmune condition (hypothyroidism, which I have to assume is attributable to Hashimoto’s, although my endo could not test for antibodies – long story which basically boils down to “you’re getting the only treatment for hypothyroid; we don’t need to know what’s caused it”) while still having hopeless resistance to colds, ‘flus, etc. I could not get my head around why, if my immune system was in overdrive, it couldn’t cope with these common infections. Suddenly, with this article, it begins to make some sense. I have been taking a Food-Grown® Immune Support supplement since just before Christmas. I could not understand why my thyroid has become so enlarged that I can hardly swallow – honestly, it feels as though someone has a hand to my throat all the time – and I was feeling even more sick than usual, but then I read this article and checked against the ingredients list, and there they were: mycelised Maitake and Oyster Mushroom powders. (The full list of ingredients can be found at http://www.wildnutrition.com/food-grown-immune-support.) I can only assume that these mushrooms (and maybe some of the other ingredients) have aggravated my thyroid condition, despite my cautious enquiries before buying and the makers’ very best intentions.

Does that sound right?

I’ve been sick for 12 years. I take synthetic thyroxine, although it’s not modulating my illness in any meaningful way (also, I often wonder what exactly it’s made from … )! I found you through a web search. Now, I’ve signed-up for your newsletters, bought and downloaded Dr Kharrazian’s e-book, and hope I might be two steps closer to cracking this conundrum.

Hi Eve, I am so sorry to hear, and honestly, I think your suspicions sound about right! Its so hard to tell with these immune stimulants, as every person is different in the way that they react, but your experience is consistent with what I feel when I am exposed to them (enlarged thyroid, “puffiness”, and fatigue). I might suggest trying to address the weak immune system with nutrients that modulate and support instead of stimulate? I have an article here you might find helpful: http://autoimmunewellness.com/cold-and-flu-remedies-for-the-autoimmune-sufferer/

The supplement I was taking was “supposed” to be modulatory rather than stimulating. I have followed up with them and they say their expert (a leading researcher who focuses solely on mushrooms) has never come across a case where mushrooms have exacerbated an pre-existing TH1-dominant condition. I suppose that means you and I are just unlucky!?!

I read the article you suggest when I first discovered your website, and am having a look at it again as I write. I have been taking vitamin D3 supplements for years, as my endo was not happy with my serum levels. I use probiotics every day. I’m upping my garlic intake, too.

I have also resumed astaxanthin supplements, having done some research since my last visit here and found that this microalgae-derived product has been found by some studies to re-balance TH1 and TH2. (An example of the studies would be, “The observed shift of the Th1/Th2 balance following treatment was probably the result of the down-regulation of Th1 cells and up-regulation of Th2 cells by the antioxidant astaxanthin” in http://onlinelibrary.wiley.com/doi/10.1046/j.1469-0691.2002.00426.x/epdf.) I have taken it previously and certainly not suffered the effects I’ve encountered now, so I’m hoping it might be able to calm down my current hypothyroid ‘flair’ with a true modulatory effect.

By the way, I note turmeric appears in your suggested list of what to avoid. This is interesting. Last year turmeric and curcumin (its active ingredient) received a lot of attention in the press as an apparent wonder-treatment for autoimmune disorders. I tried it, hated the taste and had a bad reaction. It’s definitely on my ‘no-no’ list.

Hi Eve! Thanks for sharing your experience. I think there is a lot to still be learned in this area, and the more people I talk to the more I see that some of these supplements work VERY well for some and seem to have the opposite effect on others. This is why I advocate for learning how to listen to the body’s signals for signs something isn’t working. Wishing you wellness!

I just thought I would get in touch to say that after around a month of taking the astaxanthin (a single 4 mg dose daily, at the same time as my omegas 3 and 6, because fats and oils help with its absorption) my swollen thyroid is almost back to normal. It’s still super-sensitive to any changes in my routine that take a toll, but nothing like as painful as it was when I first commented on this post. Obviously I’m not advocating it for everyone/anyone else (advocacy is not my area) but I thought others might be interested in how the story played out.

You are quite right that we all have to listen to and understand our own bodies. Of course, for many of us the frustration then becomes that our doctors do not respect what that intimate understanding is telling us.

[…] cell becomes dominant over the others, and our bodies’ defenses end up attacking us. Many herbs (including herbal antibiotics), probiotics and other supplements have a side effect of stimulating […]

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